We have always paid a great deal of attention to issues that affect what is now becoming a much more publicized and researched issue, namely the oral-systemic link as it relates to your health.  We’ve always known that there is a huge connection between the health of your mouth and your general health.  In the last few years, research is confirming that connection.  One impact on both is the use of bisphosphonate drugs, such as Fosamax, Zometa, Reclast, Boniva, etc. They have a potentially significant impact on both oral and systemic health.

There has been a great deal written about the benefits and risks of bisphosphonate therapy to treat or prevent osteoporosis, especially in the last ten years.  Many of you, primarily women, have asked me my opinion since there has been a legitimate concern about oral problems in people who have taken one of the bisphosphonate drugs.

The main concern has been a fear of osteonecrosis of the jaw (ONJ) which has been reported as occurring in people taking the bisphosphonate drugs in a far higher than normal rate of occurrence.  Today, the discussion truly needs to be broadened beyond the bisphosphonate drugs to include other, newer medications, that function in similar ways, i.e., they prevent the resorption of bone that occurs in osteopenia and osteoporosis. 

So if I’m saying there is a fear of osteonecrosis of the jaw, what IS it?  Osteonecrosis of the jaw is a severe bone disease that can affect either the upper or lower jaw.  It causes destruction of the bone and can be progressive.  It can be extremely painful, but there is not always pain present.  The most effective treatment for it is to remove the damaged bone surgically, but that sometimes leads to further development of the disease on adjacent bone. 

Some of the initial research was reporting extremely high rates of ONJ in people taking bisphosphonates – some in the 10% range.  While ONJ was reportedly occurring primarily in women who were taking high doses of bisphosphonate therapy to treat breast cancer that had spread to their bones, it was also occurring in people taking much smaller doses to treat osteoporosis and osteopenia.  That was forcing many people, primarily women, to make a choice between avoiding possible ONJ and avoiding possible hip or spinal fractures due to osteoporosis. 

The Journal of the American Dental Association, in its November issue, (JADA 2011; 142(11):1243-1251) published an updated report based on a review of research and other literature that has been published since its previous advisory statement that was released in 2008.  This statement is much more positive than the last one.  The report indicates that the highest reliable estimate of antiresorptive agent-induced osteonecrosis of the jaw (ARONJ) is approximately 0.10%.  That translates to an incidence of 1 per 1,000 people taking any of these drugs.  (This study broadened the focus beyond bisphosphonates to include other related drugs used to treat similar diseases and lumped them all into the category of “antiresorptive agents”, thus the new abbreviation of ARONJ.)

The incidence of severe problems related to osteoporosis is far higher than the percentage of risk for ARONJ, so the recommendation is becoming more clear: if your medical doctor recommends that you take one of the anti-resorptive drugs to treat osteoporosis or other medical conditions, strongly consider taking his/her advice. 

Combining the already low risk of developing ARONJ with meticulous oral hygiene will certainly lower your risk even further.  That’s true because one of the precipitating factors to developing ARONJ is having a tooth extracted or requiring other bone surgery in your jaw.  If you are keeping your mouth in excellent health, your risk of needing any oral surgery is greatly reduced, thus also reducing your risk of developing ARONJ.

I’m delighted to be able to share this with all of you, since I know many of you have anguished over the decision about whether or not to take one of these drugs.  This will significantly reduce your risk of one of the major side effects. 

Please remember that getting an adequate amount of calcium and vitamin D on a daily basis along with performing regular weight bearing exercise will also help control or prevent osteoporosis.  Remember also, the healthier your bones are, the healthier your whole body, including your mouth, will be.

As always, our goal is to help you stay healthy.  Sometimes we can accomplish that through treatment, sometimes by coaching, and sometimes by keeping you well informed about how you can best stay healthy or improve your health.  All of which is our way of “helping you with healthy habits”, a cornerstone of the Kuttler Dental Team’s approach to your care.  Certainly helping you maintain good dental health means we need to pay attention to your total health—and the opposite is just as true.  The healthier we can help you keep your mouth, the healthier the rest of you is likely to be!

--Bill Kuttler, D.D.S.

Recently I was introduced to a magazine called The Sun by a good friend of ours.  I loved it!  She loaned us her January issue, and it contained a variety of articles related to health—a topic of great interest to all of us at Kuttler Dental.  I appreciated the excerpted portion from Normal Cousins’ book entitled Anatomy of an Illness.  Although I’ve read the book before, it was a refreshing reminder of the patient’s perspective, and I appreciated the reminder.

However, the article that I want to highlight was an interview with Dr. Andrew Weil titled “Vital Signs; Dr. Andrew Weil Diagnoses Western Medicine”. Although western medicine was the subject, much of the article could have just as easily been focused on dentistry.  Both medical doctors and dentists are all trained to treat disease far more than we are to prevent it—although I’m happy to say that I believe dentistry has always been in the forefront of prevention and has emphasized it for many years.

Dr. Weil speaks of integrative medicine which he defines as “first and foremost focusing on the body’s natural healing potential, which has been ignored in conventional medical education and training.”He further explains the concept:

• Integrative medicine looks at the whole person, because patients are more than physical bodies. To understand health and illness you’ve got to look at the mental and emotional and spiritual dimensions, not to mention the person’s involvement in a community. If you pay attention only to the physical body, you limit your interventions to those that are often the most expensive and the most potentially harmful.

• Integrative medicine focuses on preventing disease and promoting health. Conventional medicine has failed us here, and that is one cause of the healthcare crisis. We are too occupied with managing cases of established diseases, most of which are lifestyle related and preventable. The essence of prevention is not colonoscopies and mammograms; it is understanding how our life choices reduce or increase the risk of disease. As a society we need to be helping people make better choices.

• Integrative medicine emphasizes the doctor-patient relationship, which was once a major reward of practicing medicine. In the era of for-profit medicine, that relationship has been sabotaged. If you work in a corporate practice that requires you to spend only five to seven minutes with each patient, you can’t form the kinds of relationships that foster healing and provide emotional satisfaction.

• Finally, integrative medicine embraces all therapeutic options that may be of value. That includes many that aren’t even on the radar of conventional medicine — simple, low-cost interventions like breath work and laughter therapy. The preference is for more-natural, less-invasive, less-expensive options whenever possible.

When I read Dr. Weil’s words, one of the big things I take away from them is that he is talking about the importance of first treating the patient and then that person’s disease.  That feels very different to me than treating the disease that happens to be occupying someone’s body.  I remember years ago hearing someone talk about the difference between saying someone is a diabetic versus saying someone has diabetes.  That has stayed with me ever since, and we’ve tried very hard to integrate that approach into our practice.  We try to care for our clients as people who may have dental problems and who almost certainly would like to prevent those problems from re-occurring in the future.

I also read Dr. Weil emphasizing the importance of forming a partnership between the physician ( I read “dentist” ) and the patient.  That resonates with me so very much, because I believe there is little we can do to effectively treat dental disease that doesn’t need to involve the person who has it.  While I can restore decayed or broken teeth, if we don’t change the environment of that person’s mouth, the problems will only re-occur.  And I don’t believe that helps anyone.

Lastly, I appreciate how Dr. Weil stresses the importance of treating the body, mind, and spirit.  While that may seem far out to some folks, especially as it relates to dentistry, I don’t agree.  In dentistry we are trying to prevent, and are treating, “life-style diseases”.  True preventive dentistry is far more than teaching someone to floss.  It is working with people to identify some of the causes of their dental problems—whether those might be cavities, gum disease, teeth-grinding, or others.  I believe those issues are significantly impacted by daily choices—their life’s style.  Whenever we are paying attention to someone’s lifestyle, I believe we are involving the entire person—truly their body, mind and spirit. 

Yes, we fix and clean teeth in our office, but we really want to help people require our services less in the future because they are healthier.  Helping people develop healthy habits is the most valuable service we offer at Kuttler Dental!

-- Bill Kuttler, D.D.S.

My day spent with Dr. Jeffrey Okeson at the Chicago Midwinter Dental Meeting last week was fascinating and helpful. He is the Director of the Orofacial Pain Program at the University of Kentucky College of Dentistry and has a very extensive academic background with a deep knowledge of research. As a result, I respect his opinions and information. And, as is often true at least for me, I resonated with him because I agree with his point of view.

Of the six hours of Dr. Okeson's presentation, he spent half of his time discussing current concepts in the causes of tempromandibular (the jaw joint known as the TMJ) disorders (referred to as TMD) that result in pain. He then reviewed various philosophies in dentistry and options for treatment in the other half of his presentation. He described five different treatment approaches based on the desired outcome for how the teeth fit and how the jaw works. This has become a very controversial topic in our profession, and treatment approaches widely vary--particularly as it pertains to the amount of treatment that is recommended in the different approaches.

I was delighted to learn Dr. Okeson's perspective is congruent with what I have learned over my years of study at the L.D. Pankey Institute. There I received ongoing post-graduate education in the area of restoring teeth to health and with attaining healthy jaw joint function.

Our approach has been research based and experience driven. We have had a great deal of success with our individualized approach, helping identify contributing habit patterns, counseling on options, and utilizing the 'less is more' philosophic approach that Dr. Okeson affirmed.

I especially smiled at Dr. Okeson's closing comments where he encouraged everyone to treat their patients in the same way that they would want their children, spouses, or parents treated - and that's the way we do it at Kuttler Dental!

--Bill Kuttler, D.D.S.